Healthcare Provider Details

I. General information

NPI: 1114106853
Provider Name (Legal Business Name): TIMOTHY WILLIAM WILKINS M.A., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43563 STATE HIGHWAY 299 E
FALL RIVER MILLS CA
96028-9787
US

IV. Provider business mailing address

3635 SUNGLOW DR
REDDING CA
96001-6144
US

V. Phone/Fax

Practice location:
  • Phone: 530-336-6535
  • Fax: 530-335-5166
Mailing address:
  • Phone: 847-275-5718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA102151
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA102151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: